enfin j'ai pu récolter le maximum d'information sur la TDM CEREBRAL en 150 diapos ! vous imaginez ! cette représentation est dédié pour les jeunes externes en medecine et internes , medecins generalistes , et les residents en neurologie
enfin j'ai pu récolter le maximum d'information sur la TDM CEREBRAL en 150 diapos ! vous imaginez ! cette représentation est dédié pour les jeunes externes en medecine et internes , medecins generalistes , et les residents en neurologie
Le médiastin est la partie du thorax située entre les deux régions pleuro-pulmonaires. C’est, donc, un espace limité dans les trois dimensions et qui contient de nombreux organes entourés d’un tissu conjonctif lâche et adipeux. Ces organes contractent entre eux des rapports étroits et assez constants.
Le médiastin est la partie du thorax située entre les deux régions pleuro-pulmonaires. C’est, donc, un espace limité dans les trois dimensions et qui contient de nombreux organes entourés d’un tissu conjonctif lâche et adipeux. Ces organes contractent entre eux des rapports étroits et assez constants.
Les différentes situations d’expertises
Expertise amiable
Expertise judiciaire
Le cadre médico-légal
Accident de circulation (AC)
Coups et blessure volontaire (CBV)
Responsabilité médicale
Accident du travail (AT)
Notion d’Incapacité
Réduction par les séquelles de la capacité physiologique
Évaluation barémique
AT : Art.38 alinéa 3 de la loi n°94/28 du 21/2/1994
AC : Art. 131 alinéa 2 de la loi n°2005-86 du 15/8/2005
L’abc della ventilazione meccanica non invasiva in urgenza.pdf.pdfSandro Zorzi
Condivido questo libro che la MCGraw Hill ha rilasciato gratuitamente per trattare i pazienti COVID19. Grazie agli autori, inoltre, per l'ottimo materiale didattico. Consiglio a tutti gli interessati la lettura.
La Target Controlled Infusion (TCI) è una modalità endovenosa di
somministrazione dei farmaci, che utilizza dei modelli farmacocinetici
elaborati su una popolazione campione e integrati in sistemi di infusione
dedicati.
TCI significa che la somministrazione del farmaco viene controllata da un
target o bersaglio, cioè un obiettivo di concentrazione impostato
dall’anestesista. Il sistema informatico si occuperà, tramite la pompa, di
raggiungere rapidamente il target e mantenerlo stabile, regolando la velocità
di infusione ed evitando sia il sovradosaggio che il sottodosaggio del
farmaco. All’anestesista non è richiesto di eseguire alcun tipo di calcolo.
A differenza dell’Anestesia Totalmente Endovenosa (TIVA - Total Intra Venous
Anesthesia), la TCI permette un fine controllo della somministrazione dei
farmaci ed una rapida variazione della concentrazione target, rendendo il
piano anestesiologico estremamente maneggevole. Un concetto implicito
nella modalità TCI infatti, è che la concentrazione target può venire modificata
ogni qual volta l’anestesista lo ritenga necessario, così da seguire in tempo
reale le varie fasi dell’intervento chirurgico, correggendo ipnosi ed analgesia
in modo puntuale.
L’accurata modulazione dell’analgo-sedazione rende la TCI uno strumento
ineguagliabile quando ci troviamo a dover sedare pazienti molto complessi al
di fuori della sala operatoria (NORA – Non Operating Room Anesthesia), con
la necessità di offrire un adeguato confort anestesiologico al paziente,
evitando accidentali sovradosaggi ed episodi di depressione respiratoria.
A. Farnia 2017
Nomenclatura per le terapie di supporto durante danno renale acutoSandro Zorzi
La gestione dei pazienti critici con danno renale acuto (AKI) che hanno bisogno di una te-
rapia di supporto renale continua (CRRT) richiede un approccio multidisciplinare. Diverse
figure professionali, quali nefrologi, rianimatori e infermieri concordano insieme quella che
è la gestione più appropriata per il paziente. L'apparente semplicità di questo processo na-
sconde un enorme grado di complessità, che richiede competenze approfondite delle di-
verse opzioni di trattamento [1]
[1].Sebbene risulti essenziale che tutti i professionisti coinvolti
utilizzino un linguaggio comune, la specifica terminologia utilizzata per descrivere le di-
verse modalità di CRRT è spesso confondente ed in continua evoluzione. Nella seguente se-
zione, verrà fornito un consensus aggiornato sulla nomenclatura da adottare riferendosi ai
diversi dispositivi delle macchine da CRRT, ai principi fondamentali alla base della tecno-
logia e dei processi di depurazione in corso di RRT, alle fasi ed ai diversi trattamenti effet-
tuabili.
C.Ronco
INVASIVE MECHANICAL VENTILATION FOR ACUTE RESPIRATORY DISTRESS SYNDROME MANAG...Sandro Zorzi
WHO Critical Care Severe Acute Respiratory Infection Training
At the end of this lecture, you will be able to:•Describe the long-term complications associated with use of sedatives in critically ill patients (firstly do no harm).•Describe the long-term benefits associated with using a protocolized management approach to pain, agitation and delirium (PAD).•Formulate a PAD protocol adapted to your hospital setting.
WHO Critical Care Severe Acute Respiratory Infection Training
HEALTHprogrammeEMERGENCIESLearning objectives At the end of this lecture, you will be able to:•Recognize acute hypoxaemic respiratory failure.•Know when to initiate invasive mechanical ventilation.•Deliver lung protective ventilation (LPV) to patients with ARDS.•Describe how to manage ARDS patients with conservative fluid strategy.•Discuss three potential interventions for severe ARDS
SEPSIS AND SEPTIC SHOCKDELIVER TARGETED RESUSCITATIONSandro Zorzi
WHO Critical Care Severe Acute Respiratory Infection Training
At the end of this lecture, you will be able to:•Describe how to deliver early, targeted resuscitation in patients (adults and children) with sepsis-induced tissue hypoperfusion and shock.•Understand the special considerations when resuscitating paediatricpatients in resource-limited settings.
SARI CRITICAL CARE TRAINING CLINICAL SYNDROMESSandro Zorzi
OPENWHO PORTAL PRESENTATION ON CORONAVIRUS
At the end of this lecture, you will be able to:•Describe the importance of early recognition of patients with SARI.•Recognize patients with severe pneumonia.•Recognize patients with ARDS.•Recognize patients with sepsis and septic shock.
PATHOPHYSIOLOGY OF SEPSIS AND ARDS / SARI PATIENTSSandro Zorzi
Presentation from the openwho elearning course on coronavirus
At the end of this lecture, you will be able to:•Describe the importance of early recognition of patients with SARI.•Recognize patients with severe pneumonia.•Recognize patients with ARDS.•Recognize patients with sepsis and septic shock.|
Overview on pain management in MSF setting. Content:
Types of pain
Assess the pain and pain scales
Treating pain according to the pain scale
All of subjected will be discussed briefly and in perspective of our work
MATERIALS:
https://emedicine.medscape.com/article/1948069-overview#a3
https://www.change-pain.com/grt-change-pain-portal/change_pain_home/chronic_pain/physician/physician_tools/picture_library/en_EN/312500026.jsp
MSF Clinical Guidelines and MSF protocols
WHO CME ANTIBIOTIC STEWARDSHIP ITALY
• Articulate the principles of antimicrobial use in surgical
prophylaxis
• Describe how key institution-specific protocols can improve
the use of antimicrobials for surgical prophylaxis
• Appreciate the importance of pre-operative dosing and limiting
prophylactic antimicrobials to the duration of the surgical
procedure
WHO CME ANTIBIOTC STEWARDSHIP ITALY
• Describe appropriate blood culture specimen collection techniques to reduce opportunities for contamination, which can lead to inappropriate antimicrobial use
• Review framework for appropriate antimicrobial prescribing for
patients with suspected blood stream infections (BSI).
• Demonstrate opportunities for collaboration between clinicians and microbiologist to achieve the dual goals of antimicrobial and
diagnostic stewardship
• Effectively use initial assessment to differentiate between viral and
bacterial respiratory tract infections determine appropriate empiric
antimicrobial therapy highlighting the importance of establishing the
correct diagnosis
• Utilize patient specific clinical and microbiologic data to reassess the
appropriateness of antimicrobial therapy
• Emphasize the role of vaccination and hand hygiene in the
prevention of lower respiratory tract infections and the role of the
clinician in educating patients about these interventions
WHO Italian CME course an antibiotic stewardship
• Understand the frequent occurrence and implications of
contaminated urine cultures and of asymptomatic bacteriuria
• Illustrate the complexity of using urinalysis and urine culture to
support the diagnosis of urinary tract infections
• Demonstrate the use of local evidence-based guidelines based
upon local antimicrobial resistance data in managing urinary tract infections
• Recognize that the majority of reported penicillin allergies are
not confirmed upon testing and expose patients to undue
harm
• Understand when diagnostic testing, including skin testing, is
indicated to confirm an antimicrobial allergy
• Employ strategies to determine if cephalosporins can be used
in patients with reported penicillin allergies.
Antimicrobial resistance for cliniciansSandro Zorzi
Slide from WHO CME ITALIAN COURSE
Antimicrobial resistance for clinicians
Core competencies for antimicrobial prescribing:
Understands the patient and the patient’s clinical needs
Understands treatment options and how they support the
patient’s clinical needs
Works in partnership with the patient and other healthcare
professionals to develop and implement a treatment plan
Communicates the treatment plan and its rationale clearly to
the patient and other health professionals
Monitors and reviews the patient’s response to treatment
Pharmacology of antimicrobials for clinicians: select topicsSandro Zorzi
Slides from the WHO Italian CME Antimicrobial stewardship
Introduce basic concepts of
pharmacokinetics/pharmacodynamics of antimicrobials
• Describe oral bioavailability of antimicrobials
• Illustrate the concept of time-dependent antimicrobials
and describe optimizing the use of beta-lactam
antibiotics using prolonged infusion.
Pain results from a variety of pathological processes and is considered as a vital sign.
It is expressed differently by each patient depending on cultural background, age, etc,etc.
IT IS A HIGHLY SUBJECTIVE EXPERIENCE MEANING THAT ONLY THE INDIVIDUAL IS ABLE TO ASSESS HIS/HER LEVEL OF PAIN.....
General anesthesia & obstetrics part IISandro Zorzi
→ Discuss indications of general anesthesia for operative delivery
→ Explain aspiration risk for general anesthesia in pregnancy and prevention strategy
Outline anaesthesia plan of care for induction, maintenance and emergency
Describe effect of volatile anaesthetics on uterine blood flow and tone
Discuss intraoperative strategies to prevent postoperative nausea and vomiting
Discuss other complications of general anaesthesia and clinical management
2. LIRE UN RADIO OU SCANNER…
USÉ AAABCS SYSTEM!!!
Ah! utilisez les dix première secondes pour tout simplement regarder évident
anomalies: asymétrie.
Accuracy, Adequacy, Alignement: l’exactitude des patients l’ensemble de la
radio ou de scanner est dans l’image, techniquement acceptable ou mieux,
tous les tranches peuvent etre consultes, pa de rotation
Bones, Blood, Brain: os, le sang, cerveau pour lo scanner cerebral
Cisterns & ventricles: citernes & ventricules pour scanner cerebral
Symmetry: symétrie
Soft tissues, Surfaces: tissus mous, les surfaces
3. LE CLICHE THORACIQUE
Le cliché thoracique est indispensable à tout bilan
pneumologique
Complète l’examen clinique
Apporte des données essentielles au diagnostic
Réalisation technique simple, application de l’utilisation des
rayons X
Le cliché thoracique reproduit un volume reproduit un volume, le
volume thoracique, sur un plan sur un plan
Il faut reconnaître sur cette reproduction plane, toutes les
4. Radiographie de 4 tubes identiques contenant calcium calcium, eau, huile, air
Celui contenant le Ca arrête les rayons X son image est blanche L’air est
transparent au rayons X son image radiologique est noire La graisse et l’eau
ont une absorption intermédiaire = gris
5. Cliché thoracique standard de qualité:
Inspiration profonde
Densité adéquate
Position correcte du patient
(cliché strictement de face)
Incidence postéro antérieure du
faisceau de rayons X (patient debout)
6. 1) Cliché insuffisamment inspiré Fausses opacités des bases
2) Même patient en inspiration correcte
9 arcs postérieurs ou 6 arcs antérieurs au-dessus du diaphragme
7.
8. 1) Aspect de gros cœur Clavicules très hautes & horizontales Cliché dos-plaque
Faisceau antéro postérieur
2) Même patient - Incidence classique Postéro-antérieure
9. 1) Patient en décubitus
2) Patient debout avec faisceau de rayons X postéro-antérieur
10. Cliché bien de face : La ligne verticale reliant les apophyses La ligne verticale
reliant les apophyses épineuses des vert pineuses des vertèbres thoraciques bres
thoraciques est au milieu des deux articulations sterno est au milieu des deux
articulations sterno-claviculaires claviculaires
11. Méthode d’analyse du cliché thoracique :
Vérifier le nom et la date
Vérifier les facteurs de bonne qualité ( bien inspiré, bien pénétré,de
face,postéro-antérieur)
Analyse de la paroi et du squelette thoracique
Analyse du médiastin